Testosterone testing in the United States: limited price transparency and significant variability

Area of Science:

• Health economics
• Clinical laboratory science
• Healthcare policy

Background:

• The Centers for Medicare & Medicaid Services (CMS) mandated hospital price transparency in 2021.
• Understanding hospital price reporting for common diagnostic tests is crucial for patient access and cost awareness.
• Testosterone testing is a common diagnostic procedure with variable pricing.

Purpose of the Study:

• To evaluate hospital-reported price transparency and price variability for testosterone (T) testing across the US.
• To identify factors influencing hospital price reporting for T tests.
• To assess the impact of the 2021 CMS regulation on T test price disclosure.

Main Methods:

• Analysis of the Turquoise database to identify hospitals reporting prices for free or total T tests.
• Comparison of hospital characteristics between price reporters and non-reporters.
• Multivariable regression to determine predictors of reporting and assess price variability by test and payer type.

Main Results:

• 51.7% of 6700 US hospitals reported at least one T test price.
• Price reporting was more common in larger, non-profit hospitals and those with higher compliance scores.
• Significant regional price variation was observed, with median prices for total T at $84.90 and free T at $92.27, differing by payer.

Conclusions:

• Despite the 2021 regulation, a substantial number of hospitals do not report T test prices.
• Price reporting is associated with hospital size and ownership type.
• Lack of price transparency contributes to significant price variation and limits consumer choice for T testing.